Provider Demographics
NPI:1043446461
Name:INTRAOPERATIVE NEUROLOGICS, LLC
Entity Type:Organization
Organization Name:INTRAOPERATIVE NEUROLOGICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-A, CNIM, DABNM
Authorized Official - Phone:303-829-6753
Mailing Address - Street 1:1026 E 6TH CIR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1502
Mailing Address - Country:US
Mailing Address - Phone:303-829-6753
Mailing Address - Fax:303-781-2779
Practice Address - Street 1:1026 E 6TH CIR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020
Practice Address - Country:US
Practice Address - Phone:303-829-6753
Practice Address - Fax:303-781-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO314231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty